An anatomically sound surgical simulation model for myringotomy and tympanostomy tube insertion.

OBJECTIVE: Myringotomy and tympanostomy tube insertion (MT) is a common surgical procedure. Although surgical simulation has proven to be an effective training tool, an anatomically sound simulation model for MT is lacking. We developed such a model and assessed its impact on the operating room performance of senior medical students. STUDY DESIGN: Prospective randomized trial. METHODS: A randomized single-blind controlled study of simulation training with the MT model versus no simulation training. Each participant was randomized to either the simulation model group or control group, after performing an initial MT procedure. Within two weeks of the first procedure, the students performed a second MT. All procedures were performed on real patients and rated with a Global Rating Scale by two attending otolaryngologists. Time to complete the MT was also recorded. RESULTS: Twenty-four senior medical students were enrolled. Control and intervention groups did not differ at baseline on their Global Rating Scale score or time to complete the MT procedure. Following simulation training, the study group received significantly higher scores (P=.005) and performed the MT procedure in significantly less time (P=.034). The control group did not improve their performance scores (P>.05) or the time to complete the procedure (P>.05). CONCLUSION: Our surgical simulation model shows promise for being a valuable teaching tool for MT for senior medical students. Such anatomically appropriate physical simulators may benefit teaching of junior trainees.

A model for training and evaluation of myringotomy and tube placement skills.

OBJECTIVES/HYPOTHESIS: Simulation is emerging as a mandatory component of surgical training and a means of demonstrating surgical competency. We designed a cost-effective, low-fidelity model to further acquisition of technical skills related to myringotomy and ventilation tube insertion (M&T). The purpose of the study was to examine the skills trainer as a method of assessment to evaluate competency, timeliness, and procedure confidence in junior residents. STUDY DESIGN: Prospective, randomized. METHODS: A simplistic M&T skills box was developed. General surgery interns (n = 20) with no prior procedure training were randomized to receive either didactic instruction or skills training using the model. One hour of lecture or technical skills training was provided to each group. A blinded examiner evaluated the subjects in both groups before and after training. Performance was measured using a global rating scale, task-specific checklist, and time-to-completion. Pre- and postsession questionnaires assessed procedure confidence. RESULTS: Analysis revealed a trend toward improvement in global rating scores between groups. There was a statistically significant difference in time improvement between groups (P = .0211). The skills lab group felt they could perform the procedure faster and with improved abilities, as compared to the didactic group (P = .0069 and 0.0007, respectively). CONCLUSIONS: Junior surgical residents performed an M&T procedure using a novel, low-cost model. This study demonstrated the skills lab's positive effect on training as measured by global rating scale, time-to-completion, and overall resident confidence. We anticipate its application to be valuable not only in training residents but also in assessing competency.

Are trainees being adequately taught myringoplasty? A prospective study of Eastern Deanery otolaryngology trainees' surgical experience.

Reviewing surgical training is an important function of a modern ENT unit, even more so following recent reform of postgraduate medical training in the UK. We have developed a tool to review otology training of Eastern Deanery trainees by constructing a middle ear surgery data base and use a commonly performed procedure, myringoplasty, to illustrate its function. Three hundred and ninety-three myringoplasty operations were identified between March 2002 and March 2006, of which 307 were included in this study as having had a myringoplasty alone uncomplicated by another middle ear procedure. Perforation closure was successful in 83% of these cases with 90% of patients experiencing a beneficial outcome regardless of supervision level. Trainees at all stages of training are being exposed to myringoplasty with an adequate de-escalation of supervision. Myringoplasty outcomes are independent of seniority, if appropriately supervised, implying that otology training in the Eastern Deanery is appropriate.

[Middle ear surgery in Mongolia--first results with middle ear prostheses]. / Erste Erfahrungen mit Prothesen in der Mittelohrchirurgie in der Mongolei.

BACKGROUND: Medical care of the Mongolian population is still far behind the standard of industrialised countries. Also in the field of otorhinolaryngology there are clear deficits in regard to an adequate diagnosis and treatment of difficult cases. Microsurgery of the ear is still in the very beginning due to missing essential equipment and surgical skills of the few ORL-units that exists in the country. The integration of tympanoplastic procedures into surgical routine is the main goal of a support programme that exists between the medical faculties of the universities of Wuerzburg (Germany) and Ulan Bator (Mongolia). The aim of this work is to present the outcome of these operations in Mongolia. METHODS AND PATIENTS: As a result of the continuous education and support programme it was possible to perform 90 tympanoplastic procedures between 2005 and 2006 in the local ORL center of Ulan Bator (EMJJ-clinic). The focus of this report is on the postoperative audiological outcome following reconstruction of the ossicular chain either using autologous ossicles or middle ear prostheses. Besides, prostheses made of polyethylene or Teflon (Russian production) as well as titanium prostheses (Kurz Company, Germany) were implanted. RESULTS: The final evaluation of the audiological results was performed 6 month postoperatively. The titanium prostheses provided the most favourable hearing improvement (mean 26 dB) when compared to the other materials (polyethylene 7 dB, Teflon 18 dB), but also compared to the autologous ossicles (8,6 dB). CONCLUSIONS: The standard tympanoplastic procedures, which were developed over decades, proved to be highly reliable also in a country with reduced medical care. The hearing results obtained especially with titanium prostheses demonstrated, that this highly biocompatible alloplastic material is the most suitable and reliable for middle ear reconstruction also in a difficult surrounding.

[A new model for training in tympanoplasty]. / Entwicklung eines Tympanoplastik-Trainingsmodells.

BACKGROUND: Functional simulation of middle ear reconstruction is a valuable tools for training in otosurgery. We introduce a new experimental model which provides a direct acoustic feedback of the functional quality of ossicular chain reconstruction. METHOD: In this model the tympanic membrane and the ossicular chain have to be reconstructed for proper sound transmission to an artificial inner ear receptor. The received signal is converted into acoustic information and consecutively provided via headphone. RESULTS: Any changes in the reconstruction (e. g. tilting the prosthesis) can be experienced online and immediately optimized by the surgeon or a trainee. CONCLUSION: The experimental model can be used for demonstration and training in otosurgery. This model is also suitable for comparing measurements of transfer functions in a calibrated version and can be applied to development and critical evaluation of middle ear prostheses.

Training opportunities for specialist registrars post-calmanization: audit of trainees' exposure to repair of the tympanic membrane.

Specialist training at the registrar grade in the United Kingdom has undergone significant change in the recent past. One of the effects has been a reduction in the length of time spent in training. This and the application of the European working time directive have the potential to reduce trainees' surgical exposure. The proportion of tympanic membrane procedures performed by reconstructive otolaryngology registrars in the Grampian University hospitals was audited to monitor the impact of these changes. Case notes of all patients who underwent myringoplasty or tympanoplasty between July 1998 and June 1999 were analysed retrospectively. Details of the surgeons' grade were recorded. The proportion of myringoplasties performed by registrars as determined by the Royal College of Surgeons of England National Comparative Audit survey, carried out in 1995 before the widespread implementation of recommended changes in otolaryngology registrar training, was set as the gold standard. In the period July 1998-1999 registrars had performed fewer myringoplasties than the standard, 17 per cent versus 34.2 per cent respectively (p = 0.035). A strategy to increase registrar exposure to myringoplasty surgery was then adopted by the department and the proportion of myringoplasties performed by registrars re-audited prospectively. The proportion of myringoplasties undertaken by registrars increased in the period January 2001 to July 2001 compared to July 1998-1999, 53 per cent versus 17 per cent respectively (p < 0.0007). Changes in working practice can address shortfalls in registrars' exposure to surgical procedures.